PROGRAM MANAGER (IDRE) - Remote

MICHIGAN PEER REVIEW ORGANIZATION• US,

2d•$90,000 - $100,000•Remote

About The Position

The Program Manager – Federal IDRE Services oversees day-to-day operations for iMPROve Health’s Federal Independent Dispute Resolution Entity (IDRE) program supporting the No Surprises Act. The role manages program operations, regulatory and contractual compliance, case workflows, and delivery of program requirements. It combines healthcare operations, regulatory compliance, project management, and hands-on team leadership, including direct supervision, coaching, and development of team members. The position requires leadership of a remote or geographically dispersed team, with consistent communication, effective virtual meetings, regular one-on-one meetings, workload and performance monitoring, and timely guidance. The manager balances operational priorities with employee development while maintaining quality, productivity, and compliance standards. This is a fully remote role requiring independent work and active collaboration with a geographically dispersed team. It operates in a fast-paced, deadline-driven healthcare environment. Occasional work outside normal business hours may be required based on business needs.

Requirements

Bachelor's degree in Nursing or a related healthcare field, or equivalent relevant education and experience.
At least five years of clinical or related healthcare experience.
At least three years of management or supervisory experience, including direct responsibility for employee performance and development.
Demonstrated experience managing a remote or geographically dispersed team, including establishing communication routines, leading virtual meetings, conducting regular one-on-one meetings, and maintaining accountability for performance.
Experience using Microsoft Teams or comparable collaboration platforms to communicate with employees, lead meetings, coordinate work, and support day-to-day team operations.
Professional experience reviewing healthcare claims.
Strong understanding of healthcare operations, medical claims, and reimbursement processes.
Excellent written and verbal communication, organizational, problem-solving, and project management skills.
Ability to interpret and apply federal and state regulations and program requirements.
Ability to manage competing priorities, monitor deadlines, and ensure timely completion of deliverables in a fast-paced environment.
Experience reviewing written and electronic documentation for accuracy, completeness, and compliance.
Proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint.

Nice To Haves

Master's degree in a relevant field.
Active nursing license.
Knowledge of the Federal No Surprises Act and Independent Dispute Resolution processes.
Utilization Management or Utilization Review experience.
Experience reviewing medical claims, explanations of benefits (EOBs), and remittance advice.
Quality improvement experience and familiarity with Lean Six Sigma methodologies.
PMP, Lean Six Sigma Green Belt, or other quality improvement certifications.
Health information technology experience.
Experience managing operational performance metrics, service-level expectations, and process improvement initiatives.

Responsibilities

Directly supervise, coach, mentor, and develop team members, including Project Specialists and Administrative Aides.
Establish clear communication practices for the remote team, including timely responses through Microsoft Teams, email, and other work-related channels.
Lead scheduled virtual team meetings, set agendas, communicate priorities, document action items, and follow through on commitments.
Conduct regular, scheduled one-on-one meetings with direct reports to discuss workloads, progress, performance, challenges, and professional development.
Set expectations for responsibilities, deliverables, deadlines, and quality standards; monitor performance and address concerns promptly.
Provide active leadership, timely guidance, and decision-making support.
Foster a collaborative, inclusive, and accountable remote work environment.
Identify training needs, support employee development, and provide constructive feedback and performance guidance.
Monitor team capacity and workload distribution, adjusting assignments and priorities as needed.
Oversee day-to-day Federal IDRE program activities, contract deliverables, case workflows, and team responsibilities.
Manage program schedules, deadlines, work assignments, and deliverables to meet contractual, regulatory, and organizational requirements.
Monitor performance metrics, productivity, quality outcomes, budgets, risks, and operational trends; identify improvement opportunities.
Develop, maintain, and implement standard operating procedures, job aids, workflow documentation, and other operational resources.
Identify workflow inefficiencies, operational challenges, and potential compliance risks; develop and implement corrective and preventive actions.
Coordinate with Arbitration Coordinators, contracted arbitrators, subject matter experts, and other stakeholders to support complete, accurate, and timely case reviews.
Apply healthcare claims review and/or clinical expertise to evaluate review processes, resolve operational issues, and improve efficiency.
Research and interpret Federal No Surprises Act regulations and related guidance from the U.S. Departments of Health and Human Services, Labor, and the Treasury.
Support contract performance, customer expectations, and continuous quality improvement through planning, monitoring, and follow-through.
Ensure program activities comply with applicable HIPAA, FISMA, URAC, CMS, contractual, and other relevant regulatory requirements.
Build and maintain productive relationships with internal teams, customers, external partners, and other stakeholders.
Communicate operational updates, emerging issues, risks, and performance concerns to leadership in a timely and professional manner.
Participate in conferences, program meetings, and professional development activities as appropriate.